Provider Demographics
NPI:1942481213
Name:BRESCIA, NICHOLAS G (RPH)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:G
Last Name:BRESCIA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 JERUSALEM AVE
Mailing Address - Street 2:
Mailing Address - City:N BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-1833
Mailing Address - Country:US
Mailing Address - Phone:516-826-3900
Mailing Address - Fax:516-826-4788
Practice Address - Street 1:2815 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-1833
Practice Address - Country:US
Practice Address - Phone:516-826-3900
Practice Address - Fax:516-826-4788
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031517183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1396845749OtherNPI